ATI RN
ATI RN Mental Health 2023 Exam 3 Questions
Extract:
Question 1 of 5
A nurse is providing teaching to the caregiver of an older adult client who has Alzheimer's disease and is being cared for at home. The client wanders at night and has a history of previous falls. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
Correct Answer: B,C,E
Rationale:
Correct Answer: B, C, E
Rationale:
B: Installing sensor devices on outside doors will alert the caregiver if the client tries to wander at night, preventing falls and ensuring safety.
C: Positioning the mattress on the floor reduces the risk of injury if the client falls out of bed during the night.
E: Putting locks at the top of doors can prevent the client from wandering outside at night, reducing the risk of falls and injuries.
Incorrect
Choices:
A: Placing the client in a reclining chair may not address the wandering issue and could lead to discomfort or pressure ulcers.
D: Encouraging physical activity prior to bedtime may increase restlessness and agitation, potentially worsening the wandering behavior.
Other options are not provided, but it's important for the caregiver to maintain a safe environment and provide appropriate supervision for the client.
Question 2 of 5
A nurse is caring for a client who is in physical restraints. Which of the following actions by the client indicates the restraints can be discontinued?
Correct Answer: B
Rationale: The correct answer is B: The client remains in control of their actions. This indicates that the client is no longer a danger to themselves or others and can be safely removed from restraints. Apologizing (
A) does not necessarily indicate safety. Asking to be released (
C) may not reflect improved behavior. Signing a contract (
D) does not ensure current safety.
Question 3 of 5
A nurse is caring for a client who has an anxiety disorder and is scheduled for a procedure. The client informs the nurse that they do not want to have the procedure. Which of the following actions should the nurse take?
Correct Answer: A
Rationale:
Correct Answer: A
Rationale: The nurse should inform the client that they have the legal right to refuse treatment at any time. This respects the client's autonomy and right to make decisions about their own healthcare. Encouraging the client to have the procedure (
B) goes against their wishes. Obtaining consent from the client's family member (
C) is not appropriate as the decision lies with the client. Requesting another nurse to review the procedure with the client (
D) may not address the client's concerns about not wanting the procedure.
Question 4 of 5
A nurse is caring for a client who has physical restraints applied. The nurse determines that the restraints should be removed when which of the following occurs?
Correct Answer: D
Rationale: The correct answer is D. When the client is able to follow commands, it indicates that they have regained control and are not a danger to themselves or others. This criterion ensures the safe removal of physical restraints.
Choice A is incorrect as orientation alone does not guarantee the client's safety.
Choice B is incorrect because medication refusal does not necessarily indicate safety.
Choice C is incorrect as the client's verbal threat of harm is not a reliable indicator of their actual intentions.
Question 5 of 5
A nurse is caring for a client who has been taking quetiapine for 1 week and reports dizziness. The client asks the nurse if the dizziness indicates an allergic reaction to the medication. Which of the following responses should the nurse make?
Correct Answer: D
Rationale: The correct answer is D: "Dizziness is a common adverse effect of the medication and is related to low blood pressure." Quetiapine, an antipsychotic medication, commonly causes dizziness as a side effect due to its potential to lower blood pressure. This response educates the client about a known side effect of the medication and provides a logical explanation for the dizziness.
Rationale for Incorrect
Choices:
A: Incorrect. Taking the medication with a meal may help reduce gastrointestinal side effects but is not directly related to dizziness.
B: Incorrect. Dizziness does not necessarily indicate an allergic response, and stopping the medication abruptly without consulting a healthcare provider can be dangerous.
C: Incorrect. The timing of medication administration does not directly affect the occurrence of dizziness associated with quetiapine.
By providing education on the common adverse effect of quetiapine and its relation to dizziness, the nurse empowers the client with knowledge and promotes safe medication management.